Long-term outcome of laparoscopic ablation therapies for unresectable hepatocellular carcinoma: a single European center experience of 426 patients

Santambrogio, Roberto; Barabino, Matteo; Bruno, Savino; Costa, M.; Ceretti, Andrea Pisani; Angiolini, Maria Rachele; Zuin, Massimo; Meloni, Franca; Opocher, Enrico

doi:10.1007/s00464-015-4468-3

Cited by 27 publications

(35 citation statements)

References 38 publications

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“…Clinical experience suggests that RFA of HCC tumors in a subcapsular location or adjacent to extrahepatic organs such as the gastrointestinal wall and gallbladder is associated with an increased risk of major complications due to heat injury [49,50,51]. The limitations of RFA for such high-risk HCC can be addressed by performing surgically assisted RFA using a laparoscopic approach [52,53]. The ability to manipulate the perihepatic environment can protect structures such as the colon, stomach, small bowel, and diaphragm from transmitted heat.…”

Section: Local Ablative Therapymentioning

confidence: 99%

A Recent Advance in Image-Guided Locoregional Therapy for Hepatocellular Carcinoma

Shi

Zhai

2016

Gastrointest Tumors

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Background: Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third most common cause of cancer-related deaths. Hepatic resection and liver transplantation are considered to be the preferred treatment for HCC. However, as novel therapeutic options such as image-guided locoregional therapies have emerged and been refined, the manner in which HCC is treated has changed dramatically compared with what it was considered just 2 decades earlier. Summary: This study reviews the current results of various image-guided locoregional therapies for treating HCC, especially focusing on thermal ablative and transarterial techniques. Key Message: Advances in image-guided locoregional therapies, including local ablative therapy and transarterial therapy, have led to a major breakthrough in the management of HCC. Both survival rates and cure rates of patients with HCC have improved markedly since the introduction of these techniques. Practical Implications: Radiofrequency ablation is currently considered as an alternative to surgical resection for patients with early-stage HCC. A newer technique of ablation such as microwave ablation is increasingly being used, especially for large HCC. Transarterial chemoembolization has become a standard care for asymptomatic patients with multinodular tumors in intermediate-stage disease, and transarterial radioembolization has become the method of choice in HCC cases with portal vein thrombosis. Moreover, combination treatment modalities, such as thermal-based ablation combined with transarterial chemoembolization or ¹²⁵I seed implant brachytherapy, may further broaden their clinical indications for HCC. Moreover, use of localized radiation in combination with thermal ablation has been reported to improve tumor control and long-term survival.

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Section: Local Ablative Therapymentioning

confidence: 99%

A Recent Advance in Image-Guided Locoregional Therapy for Hepatocellular Carcinoma

Shi

Zhai

2016

Gastrointest Tumors

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“…13,15,25 In an European study of 426 patients who underwent RFA for HCC, Santambrogio et al reported 34% overall survival at 5 years. 12 The median follow up interval in their study was 37.2 months (range 2-193 months). When compared with this European study, our finding of 38.5% five year overall survival in HCC group compares favorably, especially with our significantly longer median follow up of 115.3 months.…”

Section: Discussionmentioning

confidence: 93%

“…Based on a subset analysis, approximately 35% patients recurred locally within 12 months post ablation. 12 It is often difficult to determine whether the development of a new HCC lesion is due to local recurrence after ablation versus multicentric tumor genesis. HCC recurrence tends to be multicentric, away from the ablation area, which is related to the carcinogenesis potential of hepatocytes affected by chronic inflammation and cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 While there have been several studies evaluating 5-year survival in small cohorts of patients undergoing RFA as part of their treatment strategy for HCC or CLM, there are only limited data on 10-year survival, which is a time interval that we believe is equivocal with cure. 3,[12][13][14][15] In this study, we sought to determine whether long-term overall survival at 10 years is obtainable in patients, who undergo RFA as part of their treatment for primary and metastatic colorectal hepatic malignancies.…”

Section: Introductionmentioning

confidence: 99%

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Longterm survival outcomes of patients undergoing treatment with radiofrequency ablation for hepatocellular carcinoma and metastatic colorectal cancer liver tumors

Sucandy

Cheek

Golas

et al. 2016

HPB

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“…Approaches include percutaneous, laparoscopic, and open RFA. Despite a lack of prospective comparative studies, there are reports of good outcomes using LRA [10,11,12,13]. Altering the patient's body position and injecting saline solution (immersion method) not only allows good tumor visualization on ultrasonography, but also enables the physical distance between the lesion and surrounding organs such as the diaphragm and gastrointestinal tract to be maintained, thus preventing thermal injury to these organs during treatment [13,14,15].…”

Section: Discussionmentioning

confidence: 99%

Short-Term Results of Laparoscopic Radiofrequency Ablation Using a Multipolar System for Localized Hepatocellular Carcinoma

et al. 2016

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Background and Aim: Multipolar radiofrequency ablation (RFA) is feasible for the treatment of hepatocellular carcinoma (HCC) for which a large ablative area is planned, and it imposes a light physical burden on patients. Multipolar RFA via the percutaneous approach is performed in the majority of cases, but the efficacy of multipolar RFA with a laparoscopic approach has rarely been studied. This study aimed to evaluate the efficacy and safety of multipolar laparoscopic RFA (LRA) for localized HCC over the short term. Methods: From January 2014 to January 2016, 77 consecutive patients with 130 HCCs treated by multipolar LRA were assessed. One to three bipolar needle applicators were inserted under laparoscopic ultrasonography guidance, regardless of tumor location. We intended to achieve parallel insertions and no-touch ablation as much as possible. Results: The median size of the main tumor was 22 mm (range, 10-42 mm). The median follow-up time was 13.6 months (range, 3.1-24.8 months). In all cases, a sufficient ablative area was obtained as planned, without thermal injury of adjacent organs. During the follow-up period, all patients were alive with no local tumor progression, while intrahepatic recurrence distant from the primary site occurred in 7 patients. The 2-year local tumor progression-free survival rate and overall cancer-free survival rate were 100 and 81.6%, respectively. There were no procedural major complications caused prolonging the hospitalization, and all patients were discharged without subjective symptoms 4-7 days after LRA. Conclusions: Multipolar LRA was efficacious in the treatment of localized HCCs by safely achieving a good ablative area.

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Long-term outcome of laparoscopic ablation therapies for unresectable hepatocellular carcinoma: a single European center experience of 426 patients

Cited by 27 publications

References 38 publications

A Recent Advance in Image-Guided Locoregional Therapy for Hepatocellular Carcinoma

A Recent Advance in Image-Guided Locoregional Therapy for Hepatocellular Carcinoma

Longterm survival outcomes of patients undergoing treatment with radiofrequency ablation for hepatocellular carcinoma and metastatic colorectal cancer liver tumors

Short-Term Results of Laparoscopic Radiofrequency Ablation Using a Multipolar System for Localized Hepatocellular Carcinoma

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